1) Gastroschisis and omphalocele are abdominal wall defects that occur during embryonic development between 4-8 weeks.
2) Gastroschisis involves herniation of the intestines through a defect to the right of the umbilicus, while omphalocele involves herniation of intestines or other organs covered by a sac through the umbilical ring.
3) Outcomes are generally better for gastroschisis which has normal bowel function and fewer associated anomalies, while omphalocele has higher rates of other defects but normal GI function.
1) Gastroschisis and omphalocele are abdominal wall defects that occur during embryonic development between 4-8 weeks.
2) Gastroschisis involves herniation of the intestines through a defect to the right of the umbilicus, while omphalocele involves herniation of intestines or other organs covered by a sac through the umbilical ring.
3) Outcomes are generally better for gastroschisis which has normal bowel function and fewer associated anomalies, while omphalocele has higher rates of other defects but normal GI function.
1) Gastroschisis and omphalocele are abdominal wall defects that occur during embryonic development between 4-8 weeks.
2) Gastroschisis involves herniation of the intestines through a defect to the right of the umbilicus, while omphalocele involves herniation of intestines or other organs covered by a sac through the umbilical ring.
3) Outcomes are generally better for gastroschisis which has normal bowel function and fewer associated anomalies, while omphalocele has higher rates of other defects but normal GI function.
1) Gastroschisis and omphalocele are abdominal wall defects that occur during embryonic development between 4-8 weeks.
2) Gastroschisis involves herniation of the intestines through a defect to the right of the umbilicus, while omphalocele involves herniation of intestines or other organs covered by a sac through the umbilical ring.
3) Outcomes are generally better for gastroschisis which has normal bowel function and fewer associated anomalies, while omphalocele has higher rates of other defects but normal GI function.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
You are on page 1/ 35
Gastroschisis vs.
Omphalocele Dr. Kevin Boykin Pediatric Surgery
Take Home #1 Prior to the late 1960s, survival for infants with gastroschisis was rare. Three major advances have led to marked improvement: Parenteral nutrition Silo closure Advances in perinatal (NICU) care
Embryology Embryo unfolds in four different directions: Cranial (thoracic & epigastric walls) Caudal (hindgut, bladder, hypogastric wall) Lateral (midgut and lateral abdominal wall)
Midgut grows rapidly from 6-10 weeks Midgut elongates faster than the abdominal wall and herniates through the umbilical ring
Embryology Normal development: Midgut rotates and returns into abdominal cavity by week 10-12 Allantois, vitelline duct, vessels obliterate Umbilicus with vein and two arteries remains Umbilical ring closes around these structures
Pathogenesis Poorly understood Depends on timing of embryologic abnormality: The earlier the event, the more complex the anomaly
4-6 Weeks: Body Stalk Defect
Head Spine Extremity abnormalities
6-7 Weeks: Gastroschisis
Believed to be caused by vascular compromise of the right abdominal wall Persistence of right umbilical vein or loss of omphalomesenteric artery on right side
7-8 Weeks Cloacal Exstrophy Extrophy of the bladder Imperforate anus Omphalocele Lower neural tube defects
7-8 Weeks Omphalocele Improper migration of fusion of the lateral folds resulting in failure of closure of the umbilical ring = persistent herniation of midgut Umbilical vessels insert on to the sac and radiate around it (important remember this)
Gastroschisis Intestinal atresia Small for gestational age Prematurity GERD Cryptorchidism
Gastroschisis Small defect (usually less than 4 cm) Occurs to the right of the umbilicus Normal abdominal wall and musculature No sac or remnant of a sac! Midgut herniated through defect Possibly duodenum, stomach, colon or gonad
Premature patient Heat preservation Respiratory support Large surface area of exposed intestine Increase fluid loss
Place patient in bowel bag
Controls heat & evaporative loss Allows monitoring of bowel
Initial Care of Gastroschisis
Goal: Primary reduction if possible! Cesarean delivery is not mandatory but allows team to be assembled If no respiratory distress is noted: Start IV line Place monitoring equipment Place NGT (evacuate stomach) Intubate then paralyze patient
Gastroschisis Pearls Close primarily if possible Silo reduction is good alternative Dont make the closure too tight Wait to feed the patient (14 days) Slow advances on feeds Expect high residuals and bilious aspirates Rectal stimulation
Postop Problems Necrotizing Enterocolitis Short gut syndrome Malabsorption Obstruction TPN-associated cholestasis Developmental delay
High Risk Gastroschisis
The following factors are associated with a more complicated post-operative course: Intestinal perforation Atresia Necrotic Segments Volvulus
Characterized by: prolonged ileus & time to tolerate feeds, longer length of stay, increased infectious complication & mortality.
Omphalocele
Omphalocele At birth look for other anomalies Echocardiogram CXR Renal ultrasound
Other more severe associated anomalies take precedence over surgical repair Exception: disruption of the sac
Omphalocele If severe pulmonary hypoplasia is present: Closure of abdomen may be impossible Treat with topical bacteriocidal agent Wait for epithelialization Fix hernia at later date
Current agents used (some toxicity):
Silvadene Betadine Triodomethane-petrolatum gauze
Small Omphalocele Usually closed primarily Very similar to gastroschisis closure Watch abdominal pressure Ligate umbilical vessels Neoumbilicus can be created
Large/Giant Omphalocele Options include: Short-term silo reduction (2 weeks) Followed by closure with mesh
Close skin flaps over amnion Fix hernia at 6-12 months of age
Postop Management Respiratory support is critical Intubation with paralysis
Nutritional support TPN initially
Meticulous wound care
Prophylactic antibiotics Watch for cellulitis, fascitis
REMEMBER Omphalocele has normal GI function but bad associated anomalies/defects survival about 60% Gastroschisis has horrible GI function but few associated anomalies/defects survival about 85-90%
Determinants of First Antenatal Visit Timing Among Pregnant Women in Antenatal Care at Kampala International University Teaching Hospital, Western Uganda
Determinants of First Antenatal Visit Timing Among Pregnant Women in Antenatal Care at Kampala International University Teaching Hospital, Western Uganda
